S173
Brachytherapy - Urology
ESTRO 2026
Stockholm, Sweden. 4 Radiation Oncology, Karolinska University Hospital, Stockholm, Sweden
Purpose/Objective: Prostate cancer is the most common malignancy among men. Evidence shows that a brachytherapy (BT) boost to external beam radiotherapy (EBRT) improves outcomes for high-risk prostate cancer [1,2]. One obstacle to wider adoption is the high demand on clinical resources. At our clinic, more than 100 patients are treated annually with a BT boost using a one- room, TRUS-based solution and an efficient workflow. The aim is to describe this workflow, which includes components to streamline needle placement and planning, and may be of value for centers with limited experience or without access to CT or MRI. In addition to being time-efficient, TRUS offers the advantage of maintaining patient position throughout the procedure, in contrast to workflows involving MRI. Material/Methods: Since 2022, more than 300 patients have been treated using the present workflow, most with high-risk prostate cancer receiving HDR brachytherapy as a boost to EBRT. All treatments are performed in a single operating room equipped with an afterloader, ultrasound system, mechanical stepper with TRUS probe mount, C-arm for X-ray imaging, and an anesthesia suite. The workflow consists of multiple steps designed to minimize uncertainties in the delineation process, needle reconstruction, and dose distribution (Figure 1). The ultrasound probe is positioned with an upward tilt to avoid pubic bone interference. Needle placement adjustments are performed using a bent stylet, developed in-house and MDR-approved, allowing precise repositioning without the need for complete needle retraction (Figure 2). The C-arm is used to verify needle depth relative to the prostate base and to assess their trajectories. Finally, a combination of automatic and manual optimization is applied to generate the treatment plan for delivery.
Conclusion: This is the largest series of salvage HDR BT for isolated SV relapses of prostate cancer. Isolated SV relapses can be successfully salvaged with HDR brachytherapy and can delay time to next line treatment. Keywords: Prostate Cancer, Recurrence References: 1. Lange M, Campion L, Ollivier L, Renouf M, Magne N, Latorzeff I, et al. Patterns of Relapse Following Radiation Therapy of Intermediate-Risk Prostate Cancer in the PROFIT Randomized Trial. Int J Radiat Oncol Biol Phys. 2025;122(2):399-406.2. Valle LF, Lehrer EJ, Markovic D, Elashoff D, Levin- Epstein R, Karnes RJ, et al. A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER). Eur Urol. 2021;80(3):280-92.3. Zumsteg ZS, Spratt DE, Romesser PB, Pei X, Zhang Z, Kollmeier M, et al. Anatomical Patterns of Recurrence Following Biochemical Relapse in the Dose Escalation Era of External Beam Radiotherapy for Prostate Cancer. J Urol. 2015;194(6):1624-30. A TRUS-based workflow for HDR prostate boost brachytherapy: developed for precision and efficiency Apostolos Raptis 1 , Josef Nilsson Dahlander 1 , Simon Dahlander 1,2 , Maria Persson 1 , Lidiane Évora dos Reis 1 , Enrique Castellanos 3 , Petr Gorzov 3 , Alexander Valdman 4,2 , Åsa Carlsson-Tedgren 2,1 1 Nuclear Medicine and Medical Physics, Karolinska University Hospital, Stockholm, Sweden. 2 Oncology/Pathology, Karolinska Institute, Stockholm, Sweden. 3 Pelvic Cancer, Karolinska University Hospital, Digital Poster 4091
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